Persistent Bleeding After Menstruation: Seeking Solutions After Medication Failure

Q: Persistent Bleeding After Menstruation: Seeking Solutions After Medication Failure

Hello： Abnormal menstruation has been initially evaluated, ruling out pregnancy or obvious tumors. <br>It is recommended to adjust the menstrual cycle over a period of three months. <br>If there is no improvement, an endometrial biopsy is advised.

Abnormal bleeding after menstruation has ended, and despite seeing a doctor and taking medication, there has been no improvement?

My last menstrual period was from May 14 to May 20, and my cycle has always been regular, around 28±3 days.
However, since the end of this period, I have been experiencing light bleeding (the color is dark red-brown).
When I exert myself slightly while using the restroom, I also notice some bleeding, occasionally with small blood clots, but there is no abdominal pain.
I have not had any sexual intercourse, so pregnancy or miscarriage can be ruled out.

I visited a gynecologist on May 24, and after an ultrasound, it was confirmed that there were no unusual tumors or conditions.
The doctor mentioned that such occurrences can happen occasionally and prescribed medication for three days to help with uterine contractions and reduce bleeding:
- Ergonovine Maleate 0.2 mg (brand name: 永信 Ergonivine)
- Acetaminophen (brand name: 杏輝 ACETAMINOPHEN)
- Tranexamic Acid 250 mg (brand name: 永信 Transamin)
After completing the medication, there has been no improvement, and I am still experiencing bleeding.
I have scheduled another appointment for June 1.

I have researched similar symptoms online and suspect that it may be related to hormonal imbalance or insufficient progesterone (this is my own guess based on the closest situation).
I would like to ask the doctor what I should do since this is the first time I have experienced such an issue, and the medication has not helped.
Will I continue to have this problem indefinitely?

C.S, 20~29 year old female. Ask Date: 2023/05/31

Dr. Lin Xinwang reply Obstetrics and Gynecology

Hello: Abnormal menstruation has been initially evaluated, ruling out pregnancy or obvious tumors.
It is recommended to adjust the menstrual cycle over a period of three months.
If there is no improvement, an endometrial biopsy is advised.

Reply Date: 2023/05/31

More Info

Persistent bleeding after menstruation can be concerning, especially when it deviates from your regular cycle. Based on your description, it seems you experienced a normal menstrual period from May 14 to May 20, but have since been experiencing light bleeding that is brownish in color, accompanied by occasional small blood clots. You have ruled out pregnancy and miscarriage, and after consulting with a gynecologist and undergoing an ultrasound, no abnormalities were found.

The medications you were prescribed, including Ergonovine (which helps contract the uterus), Acetaminophen (a pain reliever), and Tranexamic Acid (which helps reduce bleeding), did not alleviate your symptoms. It’s understandable to feel frustrated and anxious about this situation, especially since it’s your first experience with such symptoms.

Understanding the Causes:
The persistent bleeding you are experiencing could be attributed to several factors, including hormonal imbalances, particularly related to estrogen and progesterone levels. Conditions such as anovulation (when the ovaries do not release an egg) can lead to irregular bleeding patterns. Other potential causes could include uterine fibroids, polyps, or even changes in your lifestyle or stress levels that may affect your hormonal balance.

Next Steps:
1. Follow-Up Appointment: Since you have already scheduled a follow-up appointment for June 1, it’s crucial to discuss your ongoing symptoms with your gynecologist. Be sure to mention the lack of improvement after medication and any other symptoms you may have noticed.

2. Further Testing: If the bleeding persists, your doctor may recommend additional tests. This could include blood tests to check hormone levels, a more detailed ultrasound, or even a hysteroscopy, which allows for a direct look inside the uterus.

3. Lifestyle Factors: Consider any recent changes in your lifestyle that might contribute to hormonal fluctuations. Stress, changes in diet, exercise, and sleep patterns can all impact menstrual cycles. Maintaining a healthy lifestyle can sometimes help regulate your cycle.

4. Medication Review: If hormonal imbalance is suspected, your doctor may consider prescribing hormonal treatments, such as birth control pills, to help regulate your cycle and reduce bleeding.

5. Monitoring Symptoms: Keep a detailed record of your symptoms, including the amount and color of bleeding, any clots, and any other symptoms like fatigue or mood changes. This information can be invaluable for your healthcare provider in determining the underlying cause.

Conclusion:
While it can be alarming to experience persistent bleeding after your menstrual period, many women encounter similar issues at some point in their lives. With proper medical evaluation and treatment, most cases can be effectively managed. It’s essential to maintain open communication with your healthcare provider and advocate for further investigation if your symptoms do not improve. Remember, you are not alone in this, and many women have successfully navigated similar challenges.

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